All That Bloats is Not Celiac Disease

In 15 years of practicing gastroenterology, I've learned that people who walk into my office thinking they have celiac disease usually don't, and people who least suspect it sometimes do. One of the reasons you can't self-diagnose celiac disease is that the list of symptoms is long and very non-specific. It includes diarrhea, constipation, weight loss, weight gain, fatigue, weakness, dry skin, smooth tongue, abdominal discomfort, joint pain, headache, smelly stools, and the most common complaint I hear: bloating. If I had a dollar for every woman who came into my office saying "help, I can't button my pants and I look like I'm seven months pregnant," I'd be richer than Oprah.

Celiac disease is an allergy to gluten, which is a substance found primarily in wheat, rye, barley, and sometimes oats. Over time, exposure to gluten in genetically susceptible individuals causes flattening of the villi--the fingerlike projections in the small intestine that are responsible for absorbing nutrients from food.

Classic celiac disease is a wasting illness, often first manifest in childhood, that consists of profound weight loss and diarrhea, but these days patients may be elderly, overweight, and constipated. Anything goes in the realm of symptoms, but the treatment remains the same: strict avoidance of gluten, frequently referred to as a gluten-free diet (GFD). Most patients with celiac disease respond extremely well to a GFD, and their symptoms as well as the changes in the small intestine gradually resolve.

But here's the rub: the vast majority of people--including the 99% of Americans who don't have celiac disease--also respond favorably to a GFD, losing weight and dramatically improving their bloating. After trying this diet, many a cyberchondriac has proclaimed him or herself cured of their purported celiac disease and embraced the gluten-free lifestyle for good.

But people like this are frequently gluten intolerant and not suffering from celiac disease. "Gluten intolerant" means your body feels better when you're eating real food rather than processed crap. That doesn't sound like a disease to me.

Our bodies aren't meant to consume large quantities of processed carbohydrates. Fruits, vegetables, legumes, nuts, seeds, and lean protein are all naturally gluten free and should be the mainstays of our diet. But manufacturers' quest for cheap, convenient food with a long shelf life has led them to put gluten in practically everything that comes in a box or package. Genetically-modified wheat is dirt cheap and a great filler.

To meet the growing demand for gluten-free products from savvy consumers, food manufacturers have come up with an endless supply of gluten-free products that swap the wheat for corn or soy. That's no triumph. The whole point of eating well is to avoid packaged, processed grains and ingredients, not to swap one for another. If you have celiac disease, you should be avoiding cookies and bagels, not eating the gluten-free version.

If the vast majority of people with bloating don't have celiac disease, then what's causing their bloating? Women bloat primarily because their colons are an average of 10 centimeters longer than men's. The female colon has to navigate around the ovaries, Fallopian tubes, and uterus--all in a wider pelvic bone--and blockages, backups, and bloating frequently occur in all those twists and turns.

Another (gender-neutral) cause of bloating is something called dysbiosis: an imbalance within the various bacterial colonies present in the colon. Simply put, there is a competition for space amongst the trillions of bacteria present in your gut. Constant assaults to the colonies from things like antibiotics, antacids, proton pump inhibitors, and chemical substances in food kill off much of the "good bacteria" and allow over-proliferation of the less beneficial strains, which release waste products such as gas. Good bacteria also play a role in maintaining the integrity of our intestinal wall and controlling the flow of bloat-causing digestive products into and out of our bloodstream--a flow dramatically disrupted when those bacteria are not present in force.

Other factors that may be responsible for your zipper to remain at half mast include fluctuating hormone levels--particularly estrogen and progesterone; the presence of carbohydrates your body can't digest, such as artificial sweeteners; high stress levels, and an insufficient amount of fiber in the diet. There's also the matter of the time of day we eat. Our gut is most active during the day and essentially goes to sleep with the setting sun. Unfortunately, that's when most of us are heading for dinner, dessert, and a midnight snack, dumping in the majority of our daily calories. Since peristalsis is much less rigorous after dark, the end result is slow movement through the intestines and lots of bloating.

But perhaps the most common cause of bloating these days is the fact that much of what we put into our digestive tract is more aptly described as "food-flavored chemicals" than actual food. Our gut has a limited repertoire for showing its displeasure, and it frequently signals our attention by bloating. Think of it as intestinal pouting.

In sum: Celiac is a real disease, associated with some bad potential complications like esophageal cancer, lymphoma, arthritis, osteoporosis, anemia, and even infertility. See a gastroenterologist if you think you really have it. But if you're simply bloated, consider some other causes. There are lots of them, including the possibility that you may have a curvy colon or that your bacteria are out of whack.

If you've not actually been diagnosed with celiac disease, don't torture yourself avoiding soy sauce and obsessing over whether a picogram of gluten might be present in everything you eat. Do eat naturally gluten-free foods like fruits and vegetables because they're healthy. Don't eat gluten free junk and think you're doing your body a favor. And remember, it could be worse; you could be 7 months pregnant AND bloated!